Ruhper Cekin

Chemotherapy‑induced nausea and vomiting (CINV) remains one of the most distressing adverse effects of highly emetogenic chemotherapy despite advances in antiemetic prophylaxis. Systemic inflammatory markers have previously been investigated as potential predictors of treatment‑associated toxicities in oncology. The present study aimed to evaluate the association between baseline neutrophil‑to‑lymphocyte ratio (NLR) and the risk of CINV in patients with breast cancer receiving anthracycline‑based chemotherapy. The present retrospective cohort included 280 female patients with histologically determined breast cancer who received anthracycline and cyclophosphamide chemotherapy at a single tertiary oncology center. Baseline neutrophil and lymphocyte counts obtained prior to chemotherapy initiation were used to calculate the NLR. Patients were categorized into two groups according to NLR values: Low NLR (2 tests and multivariate logistic regression analyses adjusting for age, menopausal status, motion sickness history, antiemetic regimen and treatment setting. Among the 280 patients included in the present analysis, 162 (57.9%) exhibited low NLR and 118 (42.1%) exhibited high NLR. Baseline demographic and clinical characteristics were comparable between the two groups. CR rates did not differ significantly between patients with low and high NLR in the overall phase (75.3 vs. 70.3%; P=0.429), acute phase (87.7 vs. 86.4%; P=0.905) or delayed phase (82.1 vs. 76.3%; P=0.296). In multivariate logistic regression analyses, NLR was found not to be an independent predictor of CINV outcomes. However, a history of motion sickness and the type of antiemetic regimen were notably associated with the likelihood of failure to achieve CR, particularly in the overall and delayed phases. Baseline NLR was found not to be independently associated with the risk of CINV in patients with breast cancer receiving highly emetogenic chemotherapy. Overall, patient‑associated susceptibility factors and antiemetic regimen selection appear to have a greater influence on CINV control compared with systemic inflammatory status as measured by NLR. Further prospective studies are warranted to explore the potential role of inflammatory biomarkers in predicting CINV.

Non-small cell lung cancer (NSCLC) represents the most prevalent histological subtype of lung malignancies, accounting for the vast majority of new diagnoses and remaining a leading cause of oncology-related mortality worldwide. Despite recent therapeutic advancements, the disease maintains a formidable clinical burden, with global incidence rates continuing to rise. Consequently, optimizing treatment sequencing and identifying predictive factors for therapy response remain critical priorities in improving long-term patient outcomes. The present study aimed to evaluate the impact of prior curative-intent treatment strategy on disease progression outcomes during first-line immunotherapy in patients with metastatic NSCLC. The present retrospective, single-center cohort study included 62 patients with advanced NSCLC who developed metastatic disease after receiving curative-intent treatment. Before metastasis, patients had been administered with either adjuvant chemotherapy or definitive chemoradiotherapy. All patients subsequently received first-line immunotherapy after developing metastatic disease. The primary endpoint was disease progression status (presence or absence) during a 24-month follow-up period. Progression-free survival (PFS) was evaluated among patients with disease progression. Results showed that during the 24-month follow-up, disease progression occurred in 33 patients (53.2%). Although not statistically significant, progression was observed more frequently in patients previously treated with adjuvant chemotherapy compared with those who had received definitive chemoradiotherapy (68.0 vs. 43.2%; P=0.055). Among the patients who developed progression, the median PFS was 7.98 months for those in the adjuvant chemotherapy group and 9.82 months for those in the definitive chemoradiotherapy group, with no statistically significant difference observed between the groups. First-line immunotherapy-related adverse events occurred at comparable rates in both groups, with the most frequent toxicities being thyroid dysfunction, pulmonary toxicity and neuropathy. In summary, compared with prior adjuvant chemotherapy, prior definitive chemoradiotherapy demonstrated a potential trend toward a lower risk of disease progression during first-line immunotherapy for metastatic NSCLC, without an associated increase in treatment-related toxicity, such as immune-related adverse events. These findings suggested that previous curative-intent treatment strategies may influence progression outcomes during subsequent immunotherapy.

Although numerous studies have explored the connection between breast cancer surgery and sexual function, research on chemotherapy’s temporal effects is limited. Addressing the impact of chemotherapy on sexual dysfunction is critical for improving quality of life. The aim of this study is to investigate changes in sexual function before, during, and after chemotherapy treatment, with a focus on associated factors. A total of 101 sexually active, reproductive-aged women diagnosed with locally advanced breast cancer were included in the study. The sexual dysfunction was evaluated by using the female sexual function index (FSFI) across 3 treatment phases: before, during, and after chemotherapy. Covariates such as age, baseline sexual dysfunction, tumor localization, comorbidity, family history of cancer, and receptor-related factors were analyzed for their influence on score changes during specific periods. A mixed-effects model was employed to evaluate associations and interactions between these variables and sexual function outcomes. Sexual function scores significantly declined across treatment phases. Notable reductions were observed in desire (P < .001), arousal (P < .001), lubrication (P < .001), orgasm (P < .01), and satisfaction (P < .01), while pain scores increased (P < .01). Total FSFI scores significantly dropped during and after chemotherapy (P < .001 and P < .01, respectively). Patients with preexisting sexual dysfunction experienced significantly greater declines in desire, lubrication, and satisfaction, along with more pronounced increases in pain-related discomfort scores, particularly in the FSFI pain subscale (P < .01). Older age, comorbidity, and tumor localization were significantly associated with worsening sexual function, whereas receptor status and histopathology showed no meaningful effect. Our findings confirm a high prevalence of sexual dysfunction among women with breast cancer. These results highlight the multifaceted impact of chemotherapy on sexual function and reveal a clear temporal pattern of changes across treatment phases.

Febrile neutropenia (FN) is a severe complication of chemotherapy, associated with substantial mortality and financial burden. The purpose of this study was to assess the association between hospital length of stay (LOS), supportive therapies, and antibiotic regimens in patients with FN, with a specific focus on the Turkish population. Eighty adult patients with solid tumors were enrolled. Patients received empirical antibiotic therapy within 2 hours of presentation. Data were collected on clinical and demographic variables, including LOS, fever duration, Multinational Association of Supportive Care in Cancer Risk Index scores, and laboratory parameters. The mean hospital LOS was 6.09 ± 3.62 days. Sulperazon use was significantly associated with a shorter LOS compared to meronem and tazocin (P < .001). Patients receiving filgrastim had a longer LOS compared to those who did not (P = .042). Correlation analysis revealed strong positive associations between LOS and febrile days (R = 0.624, P < .001), febrile days during hospitalization (R = 0.711, P < .001), and filgrastim administration days (R = 0.722, P < .001). Multivariate analysis confirmed that sulperazon use reduced LOS by 1.271 days (P = .048), while prolonged filgrastim use was linked to longer stays (P < .001). These findings highlight the critical role of antibiotic selection and supportive care in managing hospitalization duration for patients with FN. The combination of certain treatments and antibiotics plays a significant role in determining the duration of hospital stays, highlighting factors to consider in patient management and treatment planning.

Background: We aimed to evaluate the data of perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy regimen in locally advanced gastric cancer (LAGC) patients with real-life experience. Methods: In this retrospective study, LAGC patients who received perioperative FLOT chemotherapy regimen between 2017 and 2020 were included. The patients were grouped according to tumor regression grade (TRG): histopathological responders (complete/moderate response) and histopathological non-responders (minimal/poor response). The factors affecting TRG were evaluated and its relationship to clinical outcome was analyzed by disease-free survival (DFS) and overall survival (OS). Results: A total of 141 LAGC patients were included. Median age of patients was 62 (range: 35–75) years of whom 69.5% were men. According to TRG, 41 (29.1%) patients were histopathological responders (College of American Pathologists (CAP)-TRG 0/1). Grade, perineural and lymphovascular invasion, clinical stage, tumor markers (Carcinoembryonic antigen (CEA) and Carbohydrate antigen (CA)19-9), radiological response, and ypTNM stage were statistically significant in univariate analysis and lymphovascular invasion was detected as an independent factor in multivariate analysis for TRG. Grade 3-4 toxicities were observed in only 28 (19.9%) patients. Two years DFS and OS rates were higher in the histopathological responder group (100% and 100%) compared to the histopathological non-responder group (59% and 52.9%) (P = 0.01 and P = 0.02, respectively). Conclusion: In our study, it was found that the FLOT regimen had a favorable TRG and a safe toxicity profile in gastric cancer patients. In addition, while lymphovascular invasion could predict TRG, the survival and disease recurrence were positively affected by the favorable TRG response.

Impact of Anti-Tumor Necrosis Factor Alpha Treatment on Lipid Profile in Patients with Rheumatoid Arthritis - Hamidiye Medical Journal

Ejmi Eurasian Journal of Medical Investigation

This study aimed to determine the differences in clinicopathological features of Turkish patients with high-risk breast cancer based on the mutation status of two breast cancer susceptibility genes (BRCA1/2) . This study enrolled patients with invasive breast cancer who have been evaluated for BRCA1/2 mutations due to the presence of high-risk factors admitted to two tertiary referral centers in Turkey. Clinical and histopathological features were analyzed in BRCA1 mutation carriers, BRCA2 mutation carriers, and non-carriers. A total of 302 patients with a mean age of 44.2±9.9 (22–82) years were included. BRCA1/2 mutation was found in 75 (24%) patients, of whom 41 (13.6%) were BRCA1 mutation carriers and 37 (12.3%) were BRCA2 mutation carriers. Moreover, 104 (34.4%) and 4 (1.3%) patients had family history of breast and ovarian carcinoma, respectively. The rates of triple negativity (56.1%), histologic grade 3 (65.9%), and lymphovascular invasion (78%) were significantly higher in BRCA1 mutation carriers than in non-carriers and BRCA2 mutation carriers. Furthermore, 87% of triple-negative BRCA1 mutation carriers had histologic grade 3 tumors compared with 38.9% in non-triple-negative BRCA1 mutation carriers, and the difference was significant. Findings of this study showed that BRCA1-related breast cancers represent a distinct group with unique pathological features, which are usually associated with a poor prognosis.

Aim: We set out in this study to investigate whether the neutrophil-to-lymphocyte ratio (NLR) is a predictor in deciding whether to either continue palliative chemotherapy or choose the best supportive care (BSC) for advanced cancer patients. Methods: Those with advanced solid tumors who had died after palliative chemotherapy were included the study. The patients were divided into two groups based on the time between the beginning of their last chemotherapy regimen and death (DCD), at ≤ 60 or > 60 days. Neutrophil-to-lymphocyte ratio was calculated using the laboratory values taken before the beginning of the last chemotherapy line. The determinant factors of ≤ 60-days DCD were examined by logistic regression analysis, and a statistical significance level of alpha was accepted as p < 0.05. Results: The study included 404 patients, with the mean age at diagnosis of 61.7±12.0 years. The mean NLR was calculated as 11.3±27.1. In the univariate analysis for determining ≤ 60-days DCD, breast and colorectal cancers, ECOG status, single agent chemotherapy usage, neutrophil count, lymphocyte count and NLR were all found to be significant factors. The cutoff value determining the ≤ 60-days DCD, was determined as NLR ≥ 3.59. In logistic regression analysis, NLR ≥ 3.59, as well as ECOG status, were found to be significant factors. Conclusion: The neutrophil-lymphocyte ratio, combined with ECOG, can predict survival in patients with solid advanced tumors and can therefore help clinicians in choosing to either administer chemotherapy to their patients or direct them to the best supportive care.